The myths, misconceptions, and prejudices surrounding substance use and abuse continue to impede recovery. Telling someone you are HIV positive, have hepatitis C, or have an STD can also be risky business. Some of the most damaging effects of stigma are the unwillingness of people to seek help and the reluctance of families to define problems and to seek help because of fears. In addition, perceptions about race and ethnicity, gender, sexual orientation, and socioeconomic status also work in conjunction with substance abuse and/or infectious disease to create barriers in terms of:

• Lack of access to culturally appropriate prevention and treatment services;
• Discriminatory public policies (e.g., the disparity in crack/cocaine sentencing); and
• Public opinion that emphasizes criminal penalties rather than treatment.

The very negative reactions and responses that some people have toward those with substance abuse problems, mental illness, and/or infection needs to be examined, particularly as we attempt to integrate programs and services through Cross-Training. Therefore, it is important to examine attitudes toward substance use disorder and infectious disease, including those of the general public, providers, and policymakers. Learning about attitudes and how they may inhibit or encourage successful implementation of programs and services in your community is critical. You may want to explore the following issues:

• How have various members of the community responded to efforts to establish and expand programs for substance abuse and/or infectious disease prevention and treatment?
  
  
• How have current attitudes about substance abuse and/or infectious disease and the resulting laws and policies helped or hindered prevention and treatment initiatives?
  
  
• What are the effects of stigma?
  
  
• How can you help to erase stigma?
  
  
• What role may language and religious beliefs play in stigma?
  
  
• What stigma reduction strategies have worked?
  
  
• What is the social purpose of stigma as it relates to substance abuse and infectious disease?
  
  
• What is the opposite of stigma?
  
  
• How can we as service providers deal with stigma amongst ourselves?

Cross-Training is key to overcoming stigma!